Early Revision Surgery for Tibial Plateau Fractures

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Abstract

Objective:

To describe patients' outcomes after revision of tibial plateau fracture fixation within 12 months of the initial surgical procedure. To assess differences in objective outcome scores [International Knee Documentation Committee (IKDC), short form-36, arthrosis score, physical examination] depending on whether patients were treated for malreduction, malunion, or nonunion.

Design:

Retrospective case series.

Patients:

Twenty-seven patients who underwent revision within 1 year of primary surgery and with a minimum follow-up of 1 year.

Main Outcome Measurement:

IKDC Subjective Knee Form, alignment, osteoarthritis, timed up and go test, range of motion, and physical and mental health (using the short form-36 survey).

Results:

At the most recent follow-up, the mean IKDC subjective knee score of all patients within the study group was 62 (SD 17). In the malreduction group, the mean was 71 (SD 17), in the malunion group the mean was 56 (SD 17), and in the nonunion group, the mean was also 56 (SD 12; χ2 0.94; P = 0.624). Comparing the malreduction group with the malunion and nonunion groups combined, there was a significantly higher IKDC score (P = 0.019) in the malreduction group.

Conclusion:

A suboptimal outcome after open reduction and internal fixation of a tibial plateau fracture is common. If the underlying cause of the fracture is malreduction, malunion, or a nonunion, salvage of the joint without a knee replacement is worthwhile. When using a strategy incorporating revision plate fixation, osteotomy (intra- and/or extraarticular), debridement, and bone grafting when needed, patients should experience favorable long-term outcomes, including less residual pain and functional limitations.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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